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How I do it? The surgical resection of the fourth ventricle choroid plexus papilloma

  • How I Do it - Tumor - Other
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Abstract

Background

The surgical resection of the large fourth ventricle choroid plexus papilloma (CPP) is complicated, where the challenge is to minimize the impairment of the vermis and the brainstem and restore the cerebrospinal fluid circulation.

Method

We report a case of large CPP that wholly occluded the fourth ventricle, extended to the Luschka foramen, and underwent radical resection via telovelar approach. The intraoperative endoscope was applied to inspect the tumor residue and the aqueduct's opening.

Conclusion

This case demonstrates the surgical nuance of the fourth ventricle CPP.

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Funding

This study was sponsored by the CAMS Innovation Fund for Medical Sciences (CIFMS, 2019-I2M-5–008) and Pudong New Area Science and Technology Development Fund (No.PKX2020-R03).

Author information

Author notes

  1. Fangyu Wang, Xingfen Su, and Weiyan Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, Fujian, China

    Fangyu Wang & Xingfen Su

  2. Department of Neurosurgery, National Regional Medical Center, The First Affiliated Hospital Binhai Campus, Fujian Medical University, Fuzhou, 350209, Fujian, China

    Fangyu Wang & Xingfen Su

  3. Nursing Department, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Weiyan Zhang

  4. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, China

    Jianping Song

  5. National Center for Neurological Disorders, Shanghai, 200040, China

    Jianping Song

  6. Neurosurgical Institute of Fudan University, Shanghai, 200040, China

    Jianping Song

  7. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China

    Jianping Song

  8. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China

    Jianping Song

  9. Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences (CAMS), Shanghai, 200040, China

    Jianping Song

  10. Department of Neurosurgery, National Regional Medical Center, Huashan Hospital Fujian Campus, Fudan University, Fuzhou, 350209, Fujian, China

    Jianping Song

Authors
  1. Fangyu Wang
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  2. Xingfen Su
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  3. Weiyan Zhang
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  4. Jianping Song
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Corresponding author

Correspondence to Jianping Song.

Ethics declarations

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Huashan Hospital Institutional Review Board (HIRB), Fudan University, Shanghai, China.

Consent to participate

It represents a video of a surgical case. The patient gave approval for this publication.

Conflict of interest

The authors declare no competing interests.

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Key points

1. The base of the CPP is the tela choroidea, and the blood supply is the PICA running through the CMF.

2. Due to ventricular system obstruction and the overproduction of cerebrospinal fluid, the patient almost always has hydrocephalus.

3. The telovelar approach by splitting the bilateral CMF is the optimal way to resect the CPP occupying the fourth ventricle.

4. The course of the PICAs and their relationship with the tumor should be well inspected since the PICA may still supply the deep cerebellar structures or nuclei.

5. During the surgery, the tela choroidea and the CMF should be fully freed to avoid excessive retraction on the vermis.

6. The blood from the fourth ventricle refluxing backward into the midbrain aqueduct should be prevented intraoperatively.

7. The Luschka foramen can be well exposed by widely opening the CMF.

8. The lower cranial nerves should be well inspected and protected while resecting the tumor growing along the CMF.

9. If the CPP has very tight adhesion to the floor of the fourth ventricle, it is preferable to leave some pieces of the tumor to protect the brainstem.

10. The endoscope is a useful adjacent tool to ensure the aqueduct was unobstructed and had no tumor residue.

This article is part of the Topical Collection on Tumor—Other

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 58426 KB) This video illustrates the surgical resection of a large fourth ventricle CPP.

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Wang, F., Su, X., Zhang, W. et al. How I do it? The surgical resection of the fourth ventricle choroid plexus papilloma. Acta Neurochir 165, 1767–1771 (2023). https://doi.org/10.1007/s00701-022-05403-7

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  • DOI: https://doi.org/10.1007/s00701-022-05403-7

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